Femoral neck in the children is composed of dense bone. This would permit stable fixation even in cases of neglected fractures. Even if the duration of the fracture is old, there would be left enough bone to hold the implant.
Failure of fixation, implant loosening or implant cut out is quite uncommon in pediatric femoral neck fractures.
Periosteum in child is very thick, much more stronger and active as compared to adults. This again confers an advantage in terms of better prospects of union following reconstruction.
The diameter of neck is small in children and this warrants accurate positioning of the implant. Presence of growth plate allows remodeling of minor deformities but also predisposes to premature epiphyseal fusion.
There is a higher incidence of avascular necrosis because of lack of vascular anastomosis between femoral head and neck.
One of the important feature in children is the tolerance of hip spica cast, which is in fact of great help in neglected fractures in case prolonged immobilization.
Difference Between A Fresh and Neglected Fracture
The femoral neck starts getting resorbed with passage of time after a fracture. As the fracture gets older, there are more chances of overriding and shortening. Contractures may develop and deformity may result.
There are not enough trabeculae in children’s femoral neck and this might produce lesser locking of the fragments together which gets even more pronounced in older fractures.